In a recently released issue of Pediatrics, Dr. Joyce R. Javier and colleagues present results (10.1542/peds.2018-0553) of a randomized controlled trial that examines a new way of recruiting parents to enroll in evidence-based parenting programs. The authors used a “culturally tailored” video, as compared to a “usual care mainstream” video, to enhance enrollment of Filipino parents and caretakers of 6- to 12-year-olds in a parenting program. The authors note that Filipinos exemplify an ethnic group that is hard-to-reach for parenting interventions, yet the potential for population-specific benefit is meaningful, due to comparatively high rates of adolescent mental health problems. The authors courageously used actual enrollment in the advertised parenting program as their outcome measure – no spoiler alert on the effectiveness of the research – please read the article to find out how well their approach worked.

The author team took both a pragmatic and a theoretical approach to the difficulties and challenges of recruiting Filipino parents to the parenting intervention. To get hands on practical advice, they used a community-partnered participatory research approach, and engaged the help of Filipino parents who had previously participated in the study team’s successful trial of an Incredible Years® School Age parenting intervention. (Incredible Years® is a manualized facilitator-led program whose goal is “to prevent and treat young children’s behavior programs and promote their social, emotional, and academic competence” (http://www.incredibleyears.com/). The parents who had participated suggested that videos of Filipino parents and leaders would be the most effective way to reach out. Design of the videos was driven by two theoretical concepts, the “Theory of Planned Behavior” and the “Health Belief Model”. I looked these up since I was uncertain what contribution the concepts might make to a “culturally tailored” video intervention. The Theory of Planned Behavior began as an effort to predict an individual’s intent to engage in a certain behavior at a certain time: it includes 6 “constructs” ranging from attitudes and motivational factors, to beliefs about peers’ opinions and social norms, to perceived ability to enact and control new behaviors.¹ The Health Belief Model is based on the idea that a person’s desire to avoid illness (or achieve health) is related to one’s belief about how effective a specific intervention is. It too has 6 constructs, which include one’s perceived susceptibility to the “illness” in question, one’s belief about its severity, and the benefits and barriers associated with the “treatment”; self-efficacy and potential cues or triggers to action were later added. ¹  

How did these concepts aid the research team? In addition to reading this article, I encourage you to view the “culturally tailored” video – the link is available in reference #43.  The video is highly engaging, and goes well beyond simply having pictures of “parents who look like me and talk like me” speaking about the parenting program. Parents talk frankly about family relationships, about Filipino “ways” of managing behavior problems, and about the challenges their children (and they) face in the United States. Dr. Javier speaks openly about health threats and disparities, including drugs and teen pregnancy. She and the parenting program “graduates” explain how and why new parenting skills have made a positive difference in their own personal lives. I found it easy to understand how the concepts above were directly integrated into the video: clearly the “illness” in question is the risky behavior of teenagers, and the “treatments” (preventive parenting skills) are presented as accessible, culturally acceptable and aligned with social norms. This study is truly inspiring, and serves as a welcome model for ways to approach challenging health disparities.

References

1. LaMorte LW. “Behavioral Change Models.”  Boston University School of Public Health, 2016. http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories-TOC.html Accessed 12/26/2018.